POPLARVILLE — Jacenta Davis of Pearl River County doesn’t mince words about the health care crisis in her rural community.

Her grandmother, Lisa, underwent a life-threatening scare in 2024. She was rushed from Poplarville to New Orleans for open heart surgery in August. Within the week, she took the 75-mile-trek again after suffering a stroke.

Davis said the emergency transport bills quickly add up, but the time they spend waiting to get to a hospital that can provide the life-saving care they need is the most troubling.

“We have a little hospital, like a Band-Aid station. They still send us to another hospital, whether it’s Hattiesburg or New Orleans,” she said.

Her story is a common one in Mississippi’s rural areas, where limited access to affordable health care has long been a challenge.

The Mississippi Trauma Care System Foundation tracks hospital trauma designations. Among the 14 facilities in southeast Mississippi, seven hold a Level IV designation — the lowest tier — primarily focused on stabilizing patients for transfer to higher-level centers. The area also includes five Level III facilities, with one in Hattiesburg and four along the Mississippi Gulf Coast, as well as two Level II hospitals: Forrest General in Hattiesburg and Memorial in Gulfport. The closest Level I trauma centers are in Mobile, Alabama, and New Orleans.

“If it’s a big emergency, then we’re taking a risk,” Davis said.

State leaders, including Mississippi Republicans House of Representatives Speaker Jason White and Lt. Gov. Delbert Hosemann, are renewing calls for Medicaid expansion to address the crisis.

At Hobnob Mississippi, a policy event hosted by the Mississippi Economic Council in October 2024, White and Hosemann emphasized covering working people who earn too little to afford private insurance.

Medicaid expansion under the 2010 Affordable Care Act would extend coverage to adults earning up to 138% of the federal poverty level — about $20,783 annually for an individual in 2024.

Despite federal incentives covering the bulk of the costs, Mississippi remains one of 10 states that haven’t expanded Medicaid. While the state Legislature has debated the issue for nearly a decade, efforts repeatedly stall due to disagreements among lawmakers.

Legislative hurdles

In 2023, the state House passed a Medicaid expansion bill by a 99-20 vote. The plan would have covered nearly 200,000 residents and brought an estimated $1 billion annually in federal funding.

The state Senate responded with a scaled-back version, proposing coverage for about 40,000 people and requiring proof of 30 hours of weekly work. According to Mississippi Today, the Senate’s proposal would have cost the state federal dollars because of the additional requirements.

The Mississippi Hospital Association’s 2024 Legislative Agenda, underscored the urgency of action, prioritizing a bolster to Medicaid, improved access to care and enacting insurance reforms.

The Kaiser Family Foundation, a health policy organization, reviewed studies of the economic impact of Medicaid expansion, finding it would create a positive impact for providers, especially at rural hospitals.

According to the foundation, “…Mississippi could realize a net fiscal benefit of $690 million over two years if expansion had been implemented in 2022; however, the fiscal incentive is available for two years whenever a state adopts expansion.”

Stabilizing rural hospitals

White argues Medicaid expansion could stabilize rural hospitals, which are buckling under the weight of unpaid medical costs. According to a Peterson-KFF Health System Tracker, “…people living in rural areas and in the South are more likely to have medical debt.”

The KFF’s analysis of the Survey of Income and Program Participation, as of 2021, 8% of adults in America had medical debt with non-metropolitan areas being the highest at 11%. Within Census regions, the South ranked highest at 10%.

From 2019 to 2021, Mississippi had a 15.2% share of adults with medical debt in a given year, the second highest in the country, followed by South Dakota at 17.6%, according to KFF.

Increased Medicaid reimbursements could prevent closures, enhance care access for low-income residents and improve health outcomes.

Richard Daughdrill, an administrator for George Regional Health System, which includes George Regional Hospital and Greene County Hospital, points to federal programs aiding rural hospitals. In March, Greene County Hospital qualified for enhanced funding under a new program targeting rural emergency hospitals — yet challenges persist.

“It’s so expensive to provide certain services,” Daughdrill said. “It’s better for us to see the patient in the emergency room or the clinic, and then refer them to get the care they need in a facility such as Forrest General or [Merit Health] Wesley or some of the hospitals in Mobile.”

Strained resources, long travel times

For many rural residents, travel is a significant barrier. Greene and George county residents report driving 25 minutes or more to access hospitals offering specialty services.

Dialysis care is particularly lacking. According to Daughdrill, at least 27 patients from George County Regional Hospital who need dialysis get care at clinics run by larger medical groups. The closest option is in Lucedale, but if the clinic’s schedule is full, patients are referred to the next closest, which is 40 miles away in Richton.

Daughdrill explains that local hospitals lack the costly machines and staff to provide dialysis services, and by referring patients to other facilities, the cost of treatment is spread out, alleviating the financial burden of one hospital providing all services.

It’s a similar situation at Highland Community Hospital in Picayune. James Turnage, the hospital administrator, said basic primary care is often available locally, but specialty services like pulmonology or orthopedic surgery require trips to larger cities.

“This poses a significant barrier for those without reliable transportation,” Turnage said. According to the American Public Transportation Association, 45% of Americans do not have access to public transportation. For rural communities with limited or no public transit systems, that means residents must rely on family, friends and neighbors to get to medical appointments.

Collaborative solutions

Efforts to address the crisis are underway. The University of Mississippi Medical Center in Jackson and the Mississippi State Department of Health are focused on improving health care access and quality across the state. The state agency promotes programs, like the Medicare Rural Hospital Flexibility Grant, to help rural facilities improve financially, operationally and their quality of care.

Legislative initiatives, such as grants and loan forgiveness for rural medical practitioners, have also shown promise. Greg Havard, CEO of George Regional Health System, praised the Mississippi Rural Physicians Scholarship Program, calling it “very helpful” and expressing hope for its expansion. The program awards educational funds to Mississippi college students who agree to complete their residency training in specified fields as well as work in the state upon graduation.

In April, the Mississippi Economic Council, the Mississippi Manufacturers Association, and the Business and Industry Political Education Committee jointly endorsed Medicaid expansion. They argued broader health care access would improve health outcomes, strengthen the workforce and enhance overall quality of life in Mississippi.

Now, advocates target the Jan. 7 start of the 2025 legislative session, hoping lawmakers can agree on coverage terms and finalize Medicaid expansion. If a bill makes it to Republican Gov. Tate Reeves’ desk, it is unknown if it would be signed.

A plan Reeves proposed in 2024 would have made the move more profitable for hospitals, according to Mississippi Today. Following that move, however, the governor made an argument to not expand Medicaid, according to SunHerald.